Delta Dental Ppo Coverage Pdf

Are you an employer looking to provide dental insurance for your employees? Group dental insurance can be a valuable addition to your benefits package, promoting good oral health and overall well-being. In this article, we will explain the basics of group dental insurance, including coverage options and policy limits, to help you make an informed decision. So, let’s dive in!

Understanding Group Dental Insurance

Group dental insurance works similarly to group health insurance and is relatively easy to quote. Unlike health insurance, dental insurance does not require medical underwriting, making it easier to qualify for and offering more options.

There are three main types of group dental plans: PPO or indemnity policies, HMO or DHMO insurance policies, and discount plans. Let’s take a closer look at each.

PPO Dental Plans

PPO dental plans are the most popular option. They offer both in-network and out-of-network benefits, allowing employees to choose any dentist they prefer. Most group dental plans provide coverage for both in-network and out-of-network treatment, with no reduction in benefits. The main difference is that out-of-network dentists are not contracted, which means you may be subject to usual reasonable and customary charges. These charges are based on the provider’s training and experience and may be higher than the insurance company’s allowed amount.

When reviewing quotes, you will come across plan designs like “100, 80, 50, $1,500” or “100, 80, 50, 50, $2,000.” The first three numbers represent the percentage of coverage for different types of services. For example, preventive services like cleanings are covered at 100%, minor services like fillings are covered at 80%, and major services like root canals and crowns are covered at 50%. Some insurance companies may allow you to categorize endodontics and periodontics as basic services, increasing coverage to 80%.

The last number in the quote indicates the annual maximum per person or the total amount the insurance company will pay in a calendar year. If orthodontic coverage is included, there may be an additional waiting period.

HMO or DHMO Dental Plans

HMO or DHMO dental plans offer lower out-of-pocket charges and higher annual limits. With these plans, patients are restricted to a network of dentists and are required to have a primary dental provider or gatekeeper. Co-payments are typically required for procedures.

Discount Dental Plans

Discount dental plans also restrict patients to a network of providers but do not require a primary care dental provider. These plans contract with dental providers to offer discounted fees. For example, a procedure that costs $500 may be charged at only $250 for plan members. It’s important to note that discount dental plans are not insurance and work best when used in combination with a PPO plan.

Rates and Considerations

Dental insurance rates have become increasingly competitive in recent years, with rates decreasing and benefits increasing. Generally, PPO or indemnity plans are the most expensive, followed by HMO or DHMO plans, and discount dental plans being the most affordable.

When choosing a dental plan for your business, you have the option to make it voluntary or employer-paid. Voluntary plans shift the cost burden to employees, while employer-paid plans offer better rates and benefits. Keep in mind that costs may increase and benefits decrease when the employer does not contribute to the plan.

How to Get a Quote

To get a quote for group dental insurance, you will need a census form that provides basic information about your employees. You can download a census form from Make You Smile and submit it directly to an insurance company, agent, broker, or general agent.

In conclusion, group dental insurance is a valuable benefit that promotes oral health and overall well-being for your employees. By understanding the different plan options and considering your budget and employee needs, you can choose the right coverage that fits your organization’s requirements. For more information and expert guidance on quoting group dental insurance, watch our video on how to quote group health insurance in 2021.

Thank you for reading, and we hope this article has been informative. Make sure to like and subscribe to our channel for more insightful employee benefit videos. Have a great day!

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